IMCAS Paris 2004 'Uses of Radiosurgery in Aesthetic Medicine'

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Radio Surgery (Radiofrequency or Radiowave Surgery) is used to remove moles, warts, skin tags and other so called ‘lumps and bumps’. It can also be used to remove small blood vessels by thermocoagulation effect. The procedure involves the passage of radio waves into the epidermis or dermis of the skin to perform the removal or reshaping of a lesion. Different types of electrodes are used depending on the type of lesion, e.g. fine needle for incision and blood vessels, wire loop for intradermal nevi, scalpel blade etc.
Patients can expect minor swelling, redness, bruising and tenderness in the area for a few days as it heals. There should not however be any bleeding due to the tissue coagulation during treatment.

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IMCAS Paris 2004 'Uses of Radiosurgery in Aesthetic Medicine'

  1. 1. An Introduction For the Treatment of Radiosurgical Procedures in Cosmetic Medicine Presented by Dr Patrick J. Treacy Ailesbury Clinic Dublin IRELAND
  2. 2. DISCLOSURE: • Dr. Patrick J. Treacy is a Cosmetic Doctor registered in Ireland for the purposes of aesthetic medicine • I have previously been registered in United Kingdom, United States, Australia, New Zealand, South Africa. • I purchased my own Radiosurgery equipment. • I have no financial interest or stock in Ellman • I receive no additional remuneration or other compensation for equipment bought by you as a result of your attendance at this IMCAS lecture.
  3. 3. THE ULTIMATE RF ENERGY SOURCE
  4. 4. MEDICAL APPLICATIONS • Dental • Dermatology • Neurosurgery • OB/GYN • Ophthalmology • Otolaryngology • Plastic Surgery . General Practice ……. and Cosmetic Medicine
  5. 5. HISTORY RADIOSURGERY •In 1976, Dr. Irving Ellman was granted a U.S. Patent on 3.8MHz high frequency 4 waveform dental RADIOSURGICAL device. There are now many studies showing the efficacy of using the 3.8MHz Frequency and the different waveforms for soft tissue applications.
  6. 6. WHY 4.0 MHz?
  7. 7. ELECTRICAL ENERGY IN MEDICINE HIGH TEMP LOW TEMP
  8. 8. ELECTRICAL ENERGY IN MEDICINE HIGH TEMP LOW TEMP
  9. 9. HIGH FREQUENCY VS. LOWHIGH FREQUENCY VS. LOW FREQUENCYFREQUENCY • Ultra High Frequency: • Low lateral heat • Excellent cosmetic results • Scalpel like incisions • European and FDA approved • Safe • Low Frequency: • High lateral heat • Poor cosmetic results • Poor surgical quality • Limits on approved procedures • Unsafe
  10. 10. HISTOPATHOLOGICAL COMPARISON TISSUE DAMAGE
  11. 11. FREQUENCY and LATERAL HEAT HIGH FREQUENCY LH = T x P x W x S F H=lateral heat, T=time, P=power intensity, =waveform, S=surface area, F=frequency
  12. 12. HISTOPATHOLOGICAL COMPARISON TISSUE DAMAGE
  13. 13. HISTOPATHOLOGICAL COMPARISON HIGH FREQUENCY LOW FREQUENCY
  14. 14. WAVELENGHT and LATERAL HEAT LOW FREQUENCY LH = T x P x W x S F LH=lateral heat, T=time, P=power intensity, W=waveform, S=surface area, F=frequency
  15. 15. Types and Characteristics of Waveforms
  16. 16. 3 BUTTON FINGERSWITCH HANDPIECE
  17. 17. CUT/COAG - Fully Rectified • 50% Cut - 50% Coagulation • Cutting with Hemostasis
  18. 18. HAEMOSTASIS - Partially Rectified • 10% Cut - 90% Coagulation • Coagulation/Retraction Direct and Indirect
  19. 19. FULGURATION • Intentional Destruction of Diseased Tissue • Deep Coagulation by Spark-gap
  20. 20. THE ELLMAN RADIOSURGERY unit I use the Surgitron Radiolase
  21. 21. SURGITRON Patented 4.0 Dual RF
  22. 22. Comparison between RADIOSURGERY and LASERS in Cosmetic Medicine
  23. 23. RADIOSURGERY vs. LASER in Cosmetic Medicine • Radiosurgery: • Very reasonably priced (Euro 2,995- 15,000) • Great aesthetic results • Superior incisions & excisions • Less lateral heat • Performs more procedures • Easy to use • Laser • High Cost • (Euro 40,000- 130,000) • High Maintenance • Lacks tactile feel in incisions • High heat build up • Inferior biopsy results • Poor in in dense
  24. 24. • Permits high degree of hemorrhage control • Good visibility of tissues • Sterilizes the incision site as it cuts • No maintenance required • Electrodes never need resharpening Advantages of 4.0 MHz Radiosurgery::
  25. 25. CUT - Fully Rectified/Filtered • 90% Cut - 10% Coagulation • Micro smooth Cutting • Minimal lateral heat • Fastest healing
  26. 26. • Permits precise planing of tissues • Little thermal effect on adjacent tissues • Good biopsy control • Electrodes are self sterilizing Advantages of 4.0 MHz Radiosurgery:
  27. 27. INCISION
  28. 28. EXCISION / BIOPSY PROCEDURES
  29. 29. COSMETIC REMOVAL OF SKIN LESIONS
  30. 30. EXCISION / BIOPSY
  31. 31. HAEMOSTASIS Monopolar Bipolar
  32. 32. BIPOLAR COAGULATION • Discrete, Pinpoint Coagulation @ 1.7MHz • Use in Hemo or Bipolar mode with Special Bipolar Cord and Foot pedal.
  33. 33. PRIMARY CARE APPLICATIONS
  34. 34. MATRIXECTOMY
  35. 35. LID LESION
  36. 36. PRIMARY CARE PROCEDURES • Skin tags • Spider Veins • Venous Lakes • Pyogenic Granulomas • Dermatofibromas • Benign Nevi • Actinic keratoses • Basal cell cancers • Biopsy for pathology • Sebaceous cysts • Lipomas • Wart Removal • Matrixectomy • Rhinophyma • Snoring procedure • Haemorrhoids • Xanthelasma • Lletz/Leep procedure • Condyloma acuminata.
  37. 37. Excision of PYOGENIC GRANULOMAExcision of PYOGENIC GRANULOMA from scalp tissuefrom scalp tissue ©EMZimmerman, 10, 2003 ©EMZimmerman, 10, 2003
  38. 38. Excision of PYOGENIC GRANULOMAExcision of PYOGENIC GRANULOMA from nail tissuefrom nail tissue ©EMZimmerman, 10, 2003 ©EMZimmerman, 10, 2003 Pre Radiosurgery Post Radiosurgery 2 months
  39. 39. Excision of WARTS from hand tissueExcision of WARTS from hand tissue ©EMZimmerman, 10, 2003
  40. 40. Excision of WARTS from hand tissueExcision of WARTS from hand tissue ©EMZimmerman, 10, 2003
  41. 41. Excision Basal Cell Carcinoma from NoseExcision Basal Cell Carcinoma from Nose
  42. 42. Excision Basal Cell Carcinoma from NoseExcision Basal Cell Carcinoma from Nose ©
  43. 43. Excision of SEBACEOUS CYST from scalpExcision of SEBACEOUS CYST from scalp
  44. 44. SPECIALISED PRIMARY CARE APPLICATIONS
  45. 45. VASECTOMY ©EMZimmerman, 10, 2003
  46. 46. LLETZ/LEEP PROCEDURE
  47. 47. LLETZ/LEEP PROCEDURE
  48. 48. Excision of CondylomaExcision of Condyloma
  49. 49. Excision of CondylomaExcision of Condyloma ©EMZimmerman, 10, 2003 ©EMZimmerman, 10, 2003
  50. 50. UPPER LID BLEPHAROPLASTY
  51. 51. MEDICAL AESTHETIC APPLICATIONS
  52. 52. COSMETIC MEDICINE PROCEDURES • Acne Scarring • Peroral Commisures • Milia • Intradermal Nevi • Skin tags • Telangiectasia • Spider Veins • Venous Lakes • Compound Nevi •Scar Revision •Epilation
  53. 53. LESION REMOVAL
  54. 54. Facial Teleangiectasia
  55. 55. Thermocoagulation of Leg VeinsThermocoagulation of Leg Veins ©EMZimmerman, 10, 2003
  56. 56. Thermocoagulation of RED Leg VeinsThermocoagulation of RED Leg Veins
  57. 57. NEW MEDICAL AESTHETIC PROCEDURES
  58. 58. Excision of PERIORAL COMMISURES from UPPER LIP ©EMZimmerman, 10, 2003 PRE RADIOSURGERY POST RADIOSURGERY
  59. 59. Excision of PERIORAL COMMISURESExcision of PERIORAL COMMISURES from UPPER LIPfrom UPPER LIP
  60. 60. Excision of PERIORAL COMMISURESExcision of PERIORAL COMMISURES from marionette areafrom marionette area ©EMZimmerman, 10, 2003 PRESENTING PROBLEM PRE PROCEDURE
  61. 61. Excision of PERIORAL COMMISURESExcision of PERIORAL COMMISURES from UPPER LIPfrom UPPER LIP ©EMZimmerman, 10, 2003 PRE RADIOSURGERY PRE RADIOSURGERY
  62. 62. Excision of PERIORAL COMMISURESExcision of PERIORAL COMMISURES from UPPER LIPfrom UPPER LIP POST RS PROCEDURE POST RADIOSURGERY
  63. 63. RHINOPHYMA WITH LOOP SHAVING TECHNIQUE
  64. 64. RHINOPHYMA
  65. 65. Excision of ACNE SCARRING from faceExcision of ACNE SCARRING from face ©EMZimmerman, 10, 2003
  66. 66. Excision of ACNE SCARRING from face ©EMZimmerman, 10, 2003
  67. 67. Protection of Dermis with Fixomull •Leave on 3-5 days •Depending on exudate •Apply Olive Oil •Remove after 30mins
  68. 68. Excision of MILIA from faceExcision of MILIA from face ©EMZimmerman, 10, 2003
  69. 69. Excision of KERATOTIC SCAR from faceExcision of KERATOTIC SCAR from face
  70. 70. Excision of Acne KERATOTIC SCARSExcision of Acne KERATOTIC SCARS Special Electrode
  71. 71. Excision of large congenitalExcision of large congenital COMPOUND NEVUS from lumbar areaCOMPOUND NEVUS from lumbar area Histopathology required
  72. 72. Removal of Benign INTADERMAL NEVI
  73. 73. Removal of Benign COMPOUND NEVUS
  74. 74. Removal of Benign Intradermal Nevus
  75. 75. Excision of COMPOUND NEVUS from lipExcision of COMPOUND NEVUS from lip
  76. 76. Removal of VENOUS LAKE from LIPRemoval of VENOUS LAKE from LIP
  77. 77. VENOUS LAKE on LIPVENOUS LAKE on LIP
  78. 78. Removal of Benign Intradermal Nevus
  79. 79. Removal of Benign Intradermal Nevus
  80. 80. EARLOBE REPAIR Electrode is suited to precision incision . Excellent healing is demonstrated
  81. 81. Excision of SEBACEOUS CYST from NeckExcision of SEBACEOUS CYST from Neck
  82. 82. Excision of Dermal Nevus from AbdomenExcision of Dermal Nevus from Abdomen
  83. 83. Excision of Dermal Nevus from AbdomenExcision of Dermal Nevus from Abdomen
  84. 84. Excision Seborrheic Keratosis from BackExcision Seborrheic Keratosis from Back
  85. 85. Excision Seborrheic Keratosis from BackExcision Seborrheic Keratosis from Back
  86. 86. CUTTINGCUTTING
  87. 87. 4.0 MHz DEVICE, ELECTRODES AND ACCESSORIES
  88. 88. SURGITRON Patented 4.0 Dual RF
  89. 89. VAPOR-VAC™II
  90. 90. THE RADIOSURGERY SYSTEM
  91. 91. 3 BUTTON FINGERSWITCH HANDPIECE
  92. 92. STANDARD PRIMARY CARE ELECTRODES
  93. 93. DISPOSABLE ELECTRODES
  94. 94. EMPIRE NEEDLE ELECTRODES: for Cutting and Coagulation
  95. 95. HAEMOSCALPEL
  96. 96. INSULATED MATRIXECTOMY ELECTRODE
  97. 97. BIPOLAR FORCEPS
  98. 98. LLETZ ELECTRODES
  99. 99. for treating broken FACIAL RED VEINS (telangiectasias) and SPIDER VEINS INSULATED MICROELECTRODE
  100. 100. INSULATED NEEDLE ELECTRODE for Telangiectasia and Epilation
  101. 101. COAGULATION /HAEMOSTATIS • Partially rectified, partially filtered. • Direct touch or grasp (bipolar forceps) • Tissue damage minimized by lifting area or vessel to be coagulated. • Penetrates more deeply, more tissue damage • If carbon/eschar forms, it acts as an insulator and will not control bleeding. Wipe it away or use another form of haemostasis.
  102. 102. RELATIVE CONTRAINDICATIONS • Pacemakers • Pregnancy • Bleeding disorders • Systemic and local infections.
  103. 103. INFORMED CONSENT: • Should educate the patient about the procedure, • risks and expected, realistic results for a procedure. • Should include all components of the procedure, • Cleaning, anesthesia to care and cosmesis. • Gives you a chance to establish patient rapport
  104. 104. QUESTIONS??
  105. 105. THANK YOU!
  106. 106. An Introduction For the Treatment of Minor Cosmetic Procedures in General Practice Presented by Dr Patrick J. Treacy Ailesbury Clinic Dublin IRELAND

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